Tetralogy of Fallot

Picture Courtesy: American Heart Association

The classic form includes four defects of the heart and its major blood vessels:

• Ventricular septal defect (hole between the right and left ventricles)
• Narrowing of the pulmonary outflow tract (the valve and artery that connect the heart with the lungs)
• Overriding aorta (the artery that carries oxygen-rich blood to the body) that is shifted over the right ventricle and ventricular septal defect, instead of coming out only from the left ventricle
• Thickened wall of the right ventricle (right ventricular hypertrophy
  Factors that increase the risk for this condition during pregnancy include:
  • Alcoholism in the mother
  • Diabetes
  • Mother who is over 40 years old
  • Poor nutrition during pregnancy
  • Rubella or other viral illnesses during pregnancy
    
    
    Courtesy: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002534/
    
    
    Surgery is now often carried out in infants one year of age or younger with less than 5% perioperative mortality. The open-heart surgery is designed (1) to relieve the right ventricular outflow tract stenosis by careful resection of muscle and (2) to repair the VSD with a Gore-Tex patch or a homograft. Additional reparative or reconstructive surgery may be done on patients as required by their particular cardiac anatomy. (courtesy Wikipedia)

LEUKOTRIENE MODIFIERS

Picture Courtesy: Healthy Palm



Leukotrienes are fatty signaling molecules. They were first found in leukocytes (hence their name). One of their roles (specifically, leukotriene D₄) is to trigger contractions in the smooth muscles lining the trachea; their overproduction is a major cause of inflammation in asthma and allergic rhinitis.


Leukotrienes act principally on a subfamily of G protein-coupled receptors. They may also act upon peroxisome proliferator-activated receptors. Leukotrienes are involved in asthmatic and allergic reactions and act to sustain inflammatory reactions. Several leukotriene receptor antagonists such as montelukast and zafirlukast are used to treat asthma. Recent research points to a role of 5-lipoxygenase in cardiovascular and neuropsychiatric illnesses
Courtesy: http://en.wikipedia.org/wiki/Leukotriene

SOME BRAND NAMES OF LEUKOTRIENE MODIFIERS (Generic names in parentheses)
Singulair (Montelukast Sodium) Approved for children 2 and older
Accolate(Zafirlukast) Approved for children 7 and older
Zyflo (Zileuton) Not approved for children
Courtesy: NY State Government :http://www.nyc.gov/html/doh/downloads/pdf/asthma/leuko.pdf

The National Institutes of Health (NIH): national asthma guidelines:
1. Inhaled corticosteroids are the most effective anti-inflammatory medications for long-term management of persistent asthma.
2.    All people with asthma should receive a written Asthma Action Plan.
3.    All patients should have an initial assessment that covers impairment and risk to determine the level of therapy needed.
4.    At planned follow-up visits, asthma patients should review their level of control with their healthcare provider based on multiple measures of current impairment and future risk in order to guide clinician decisions to either maintain or adjust therapy.
5.    Patients who have asthma should be scheduled for planned follow-up visits at periodic intervals in order to assess their asthma control and modify treatment, if needed.
6.    Clinicians should review each patient’s exposure to allergens and irritants and provide a multi-pronged strategy to reduce exposure to those allergens and irritants that make a patient’s asthma worse.